Before the Bulkley Valley District Hospital (BVDH) got its CT scanner, the hospital’s stroke treatment was essentially getting a patient to Terrace as quickly as possible.
Due to the nature of strokes, which can be caused by brain bleeds or blockages and require a CT scan to determine which is present, a patient exhibiting symptoms would be shipped off to Terrace for a CT scan, where the cause of the stroke could be determined.
The only problem? Time.
In the case of strokes where the cause is a blockage, the clot-busting medication the patient requires must be given within four hours of symptoms.
That isn’t much time once a patient has been picked up by an ambulance, brought to BVDH, assessed and sent off to Mills Memorial Hospital in Terrace, said Dr. Mallory Quinn of BVDH.
“Up until this point we weren’t quite able to give good stroke care in the Northwest,” said Quinn.
“By the time they would come in here, we would assess them, we would get them back in the ambulance, we’d drive them to Terrace, they’d get a scan [and] they’d be outside of that four-hour window.”
Realizing a new CT scanner, which the hospital got back in July, meant they would be dealing with strokes in a new, more intimate capacity, Quinn reached out to an old preceptor who she trained with at a northern medical program.
“He kind of said, ‘oh, actually there’s this pilot you could try out of VGH (Vancouver General Hospital)’,” Quinn said.
The Hot Stroke protocol refers to a new pilot program in which VGH stroke neurosurgeons are connected with rural hospitals via an ultra-HD, high-speed video link as part of a province-wide tele-medicine program.
Quinn said BVDH is the northernmost site for the pilot program.
Because the BVDH’s emergency room is entirely staffed by family doctors, Quinn said the decision to take part in the program was a no-brainer, as it would help these doctors (many of which have never had to administer things like clot-busting medication for strokes) make critical, time-sensitive decisions about stroke patients.
The connected neurosurgeon has access to any scans (in this case usually CT imaging) or tests the hospital has run on the patient and can make the same recommendations they would if the patient were at VGH in their direct care.
“When we have a stroke come in we get them in the scanner right away, they get their scan and then we get a neurologist from VGH on,” Quinn explained.
“They come on the screen they’ll do an exam of the patient in conjunction with us and then they’ll look at the imaging and they’ll give us the advice as to what treatments would be appropriate in that case.”
Quinn said the program is helpful because of a secondary treatment for clot-based strokes where clots are located in large vessels.
“They’ll basically take them down to Vancouver and suck the clot out surgically.”
Quinn said because of a 12-hour time window to get the surgery done they were running into the same issue as with the clot-busting medicine: not enough time to send someone to VGH once the person has been diagnosed in Terrace.
Now she said this is changing and a couple of people have been able to make it down for the procedure, known as an endarterectomy, since the pilot program began.
Overall, the program has helping massively in terms of dealing with strokes in the Bulkley Valley, Quinn said.
“It’s kind of revolutionized what we can do for strokes locally and actually getting people out in a timely manner for what they need.”
The camera is high-definition enough that Quinn said doctors on the VGH end have remarked they are able to see things as specific as slight pupil dilation.
“They have such good resolution on the camera on the top of that, that they were, like, ‘yeah I can see their pupils, I can zoom in and check their eyes,’ so it’s a whole other level compared to Skype.”
Quinn also said a recently-installed improved landing system at Smithers Regional Airport has also increased the success rate for incoming planes being able to land successfully and not have to turn back.
Robbie Dunbar, clinical practice leader and registered nurse at BVDH said anyone who thinks they or another person is having a stroke should not wait and it’s crucial to get someone to the hospital as soon as possible if they are displaying any stroke-related symptoms such as facial drooping, arm weakness and speech difficulties.
“It’s easy for us to tell people you’re OK, it actually wasn’t a stroke or something, but when someone decides to go to bed and check it in the morning sometimes they’ve gone out of that window.”
The BVDH’s CT scanner officially went into service July 12, 2019. In early October, the scanner performed its 1,000th scan.